title: Percutaneous endoscopic gastrostomy in children: Is early feeding safe?
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide nutritional support for patients with normal gastrointestinal function but cannot be fed orally for a variety of reasons. Owing to safety concerns, the first feeding after PEG tube placement is generally delayed. Early feeding may be an option; however, childhood studies regarding early feeding after the PEG procedure are highly insufficient.
  
  
  METHODS
  A prospective randomized controlled study was conducted to compare early (4th hour) and late (12th hour) feeding after the PEG procedure. The PEG process was performed with the standard pull technique. Prophylactic antimicrobial drugs were not used. Complications such as gastric residue after feeding, vomiting, fever, systemic signs of infection, and duration of hospital stay were recorded. Tube feeding training was given to parents during their stay in the hospital in both groups. In the first and third days following PEG, the patients were visited by an experienced nurse in their homes and evaluated in terms of potential complications.
  
  
  RESULTS
  The study was completed with a total of 69 patients: 35 in the early feeding group and 34 in the late feeding group. The demographic characteristics of the groups were similar. Vomiting was rare and detected as similar in both groups (early feeding group 8.5% [3/35], late feeding group 8.8% [3/34], P = 1.00). Rarely, minor gastric residue was observed in both groups (early feeding group 11.4%, late feeding group 8.8% [P = 1.00]). The amount of gastric residue in the early feeding group was a maximum of 13.2 mL, whereas the late feeding group had a maximum of 14.3 mL. The average duration of stay in the hospital for the early and late feeding groups was calculated as 6.7 ± 0.64 and 28.3 ± 3.74 hours, respectively (P < 0.001). Leakage from gastrostomy fistulas, peritonitis, and aspiration were not observed in any patients.
  
  
  CONCLUSIONS
  The feeding at the fourth hour after PEG placement was safe and well tolerated by patients and shortened the duration of the hospital stay. The use of prophylactic antibiotics seems to be unnecessary before the procedure.
authors.affiliation: Department of Pediatric Gastroenterology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Islek
authors.forename: Ersin
authors.initials: E
authors.lastname: Sayar
authors.forename: Aygen
authors.initials: A
authors.lastname: Yilmaz
authors.forename: Reha
authors.initials: R
authors.lastname: Artan
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015930:Diet Records; D004750:Enteral Nutrition / Q000009:adverse effects*; D019959:Feeding and Eating Disorders of Childhood / Q000209:etiology / Q000628:therapy*; D005260:Female; D005746:Gastric Emptying; D005773:Gastroscopy / Q000009:adverse effects*; D005774:Gastrostomy / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D011182:Postoperative Care / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D014421:Turkey / Q000453:epidemiology